Analysis of Medical Situations - Assignment Example

Student names Instructor Unit Code Date Question 1: The Case of Mr. Gregory When Mr. Gregory took ill, a test confirmed that he had cancer. An attempt to perform chemotherapy was unsuccessful, which led to the option to perform cardio-oesphagetomy surgery. The operation saw his mid abdominal opened as his oesophagus was removed so as get rid of the areas that had been affected by the cancer, and subsequently save his life. In medical treatments such as surgical procedures, there exists risk factors that can result due to the operations. When a person undergoes cardio-oesphagetomy, they are at the risk of suffering from operative pulmonary complications (PPC). For Mr. Gregory, he suffered from the right lower lobe atelectasis four days after his operation. To determine why this happened, we will look at the risk factors of PPC, the risk factors that lead to atelectasis, and the factors that ultimately contributed to this complication. PPC is affected by the prior health of a patient, the effects that anaesthesia has on the patient and the surgery that the person undergoes. These effects often determine how risky it is for a patient to develop atelectasis. Smetana identified obesity, advancement in age, cigarette smoking, some surgeries and the use of general anaesthesia as risk factors that play a part in PPC developments (581). For our patient, Mr. Gregory, some of these factors ring true. Mr. Gregory was a chain-smoker for 40 years and smoked some 30 cigarettes in a day. He only quit after he was diagnosed with cancer. He was also operated on under the influence of the general anaesthesia following the anaesthetist checking to ensure that it was adequate for him. Atelectasis is a PPC condition in which the lung lobes or the lung fully or partially collapses as a result of shrinking alveoli. It often takes place after a surgery and in a patient who is advanced in age, suffers cough obstruction and lacks movement. Two of the most common causes related to atelectasis are recent surgery, especially thoracic or abdominal surgery and being under the influence of anaesthesia recently. While Mr. Gregory did suffer from lack of movement following his operation for a few days and sometimes could not cough, the tipping point was the fact that his surgery was abdominal in nature and that a general anaesthesia was used during his surgery. Coupled with the fact that he was already at the risk of PPC from previous discussion, these two factors increased his chances of developing atelectasis. Another factor that lead to atelectasis was the fact that on the fourth day, Mr. Gregory contracted pneumonia. When his sputum culture was tested, it revealed that he had contracted streptococcus pneumoniae, which leads to the development of pneumonia. Pneumonia is actually a common occurrence in post-operative surgeries and a common PPC. In fact, it is so common that studies have recorded high chances of patients developing pneumonia after surgery. Some of these studies include Brooks (564) and Smetana et al. (581) who discovered that pneumonia was most frequent PPC. For Mr. Gregory, he developed right lower lobe atelectasis four days after his operation because of various factors that played a key role such as an abdominal surgery, the recent use of general anaesthesia, development of pneumonia among others. Question 2: The Case of Mr. Aston Mr. Patrick Aston is a retired postman who was admitted in hospital because of a painful left leg. He could not sleep because of the pain. He also did not want to extend the leg due to the pain. It was recorded that his leg was throbbing with a lot of pain. The leg also had the odour of green gangrene. It was suggested that his treatment will be a left trans-tibial amputation. Mr. Aston will face several problems currently (that is, between now and surgery) and postoperative problems. Some of these problems are in relation to his mobility, ability to take care of himself, ability to manage his pain, and ability to independently carry out tasks such as cooking, cleaning, washing, etc. Currently, Mr. Aston is dealing with the problem of mobility. While he was able to go about his business without the help of walking aids such as walkers, he is unable to make it to the toilet without some the help of a wheelchair. Another problem that he currently is facing is the amount of pain that he is experiencing as he waits for the operation. After the surgery, Mr. Aston will have new problems such as lack of independence for a while, pain, and possibilities of wound infections. Because of his loss of this left leg, Mr. Aston has to learn how to be independent with the residual stump and using aids. The pain will still be present albeit less because of residual limb pain. Mr. Aston will also have to deal with problems such as oedema and wound infections that can occur. A detailed list of the problems that Mr. Aston will deal with is tabulated in Appendix A. Mr. Aston’s treatment should be carried out in a manner that is beneficial for him. Some of the interventions include, creating a wearing schedule for the prosthesis, assist the patient in walking to gain independence again, teach the client to manage transfers, teach the client to wrap the stump properly, and teach the patient how to maintain the range of motion to avoid knee or hip contractures. All these interventions are useful in ensuring that the patient is able to once again be independent, be more mobile, learn how to manage properly the residual limp, and teach the patient on how to continue living a more fulfilled life with the new life changes that have been made (Se Appendix B for further details). Preventing wound infections One of the problems that Mr. Aston will face is wound infections around the area where he was amputated. When being used, the prosthesis socket forms a airtight, dam, warm contained area in which the sweat and natural body oils can collect. This creates an environment conducive for bacteria growth, which can lead to infection development. Damp skin around the area will also break down giving the bacteria a very easy way to enter the body. Consequently, the infection might spread causing serious health problems. Some of the signs that an infection has taken place is the formation of blisters, rashes, tender spots and pus discharge (Baird). A bad odour could be an indication that there is an infection. An infected part can lead to a spread infection such as cellulitis or scabby rush. In addition, the infection can cause fever. Preventative measures that can be taken to prevent wound infection in the residual limb is to wash the area with antibacterial soap at least once in a day. The soap should not be scented. For patients who sweat a lot or have the tendency to get rashes or infections easily, they should was the region well. If sprays are used, they should not be scented. Mr. Aston should also avoid using lotions because they dry the skin, which increases the risk of skin Breakdown. In addition to the stump, Mr. Aston should also ensure that the wrapper, the socket and the prosthetic soap are thoroughly washed on a daily basis in antibacterial soap and water. The effectiveness of the physiotherapy treatment When it comes to monitoring the effectiveness of the physiotherapy treatment, the best method is to have a set of questions. These set of questions can either be targeted or specific. Targeted questionnaires can target a specific intervention and measure the effectiveness of the treatment specifically. For example, if a physiotherapist wants to measure the range of motion of an amputated patient, they are able to do so by recording down the different range of motions that the patient is able to do. This helps to determine if a patient is progressing and whether the intervention being used is helping our not. By recording various measurements required such as the accomplishments of the patient in relation to their ability to do successfully transfers, or their ability to climb the stairs, a physiotherapist is able to determine the rate at which the interventions are working, whether they are causing excessive pain to the patient and whether to continue with the treatment or not. Question 3 Mr. Bury is a patient whose condition has exacerbated. He has Chronic Obstructive Pulmonary Disease. Because of his improved health, Mr. Bury is set to leave for home. To ensure that his situation continues to improve after discharge, then a multidisciplinary intervention is needed. The first thing required is a diet intervention. Mr. Bury needs to eat nutritious food and eat well. His food should be packed with vegetables, proteins and calories. Calories will help in provide energy to the patient, which he will need more considering his condition. The improved diet will also be essential in boosting his immunity due to proper eating, which gives the body all the necessary ingredients to produce white blood cells that assist in fighting off infections. The patient will need high immunity more now because of his chronic disease. This is because another strong infection can lead to fatal healthcare consequences. Therefore, by eating properly, Mr. Aston will help his body in fighting other infections that might attack his already compromised immune system. Mr. Bury also needs to drink a lot of fluids to keep hydrated. Water helps in the body for digestion and also to regulate body fluids. When Mr. Bury is well hydrated, his respiratory tubes will also benefit because there will be mucus covering them to avoid a dry patched area. The consumption of calcium filled foods such as milk (if not allergic) will help to store up more calcium in his body. The calcium is essential in order to keep his bones from becoming frail, which can cause accidents and brokerage, leading to more hospital visits and an overtaxing of the immune system. A healthy diet will help Mr. Bury to be healthy and maintain his health while at the same time with help to improve his breathing if his food is reach in potassium. The most important intervention so that Mr. Bury is able to self-manage (Watson 1267) is education. For a patient such as Bury, he needs to be educated on how to manage COPD. In particular, he needs to understand the condition, the meaning of his condition and how it affects his life. Consequently, the patient needs to be able to grasp the dos and don’ts to mitigate the condition. Therefore, the education sessions are important because they will offer the information and explanations of the above mentioned factors to the patient. The education sessions can be done either through face to face discussion with a physician or can be provided through videos, written material. The education can also be done in a group setting. While all the above interventions are of great importance, the one that is essential is the one that directly has an impact on his health. Mr. Bury is addicted to nicotine as evidenced from his 30 to 40 cigarettes a day smoking rate. Now, with his COPD diagnosis, Mr. Bury should cease to smoke at once. Smoking is going to affect his respiratory processes, leading to laboured breathes and coughing. The more indulges in the smoking behaviour, the more he is most likely to endanger himself. Smoking is a risk factor because it can lead to a decrease in lung functioning (Troosters 19). To help Mr. Bury stop smoking, drug intervention and counselling should be used. In addition, the patient can be referred to a group therapy. In avoiding the urge to smoke, he will give his body better chances to maintain his improved health. Work Cited Baird, James. Skin Care of the Residual Limb. Merck Manual Consumer Version, n. d. Web. 3 Sept 2017. Brooks, Ann. “Predictors of Postoperative Pulmonary Complications Following Abdominal Surgery’. Chest 111.3 (1997): 564-571. Smetana, Gerald, et al. “Preoperative Pulmonary Risk Stratification for Non cardiothoracic Surgery.” Ann Intern Med 144.8 (2006): 581-95. Troosters Thierry, et al., “Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease.” Am J Respir Crit Care Med. 172.1 (2005):19–38. Watson PB., et al. “Evaluation of A Self-Management Plan for Chronic Obstructive Pulmonary Disease.” Eur Respir J. 10.6 (1997):1267–71. Appendix A Current and Postoperative problems that Mr. Aston will face. Current Problems Area of Problem Explanation 1 Mobility Currently, Mr. Aston is awaiting surgery. However, his mobility is extremely limited because of the excruciating pain and therefore prefers not to move. When he does require to move, he is making use of the wheel chair. 2 Toileting At the moment, Mr. Aston needs assistance in order to go to the bathroom and us using a wheelchair to do so. 3 Pain Mr. Aston is experiencing a lot of pain and describes it as throbbing and burning. The pain is interfering with his sleep. Postoperative problems 3 Mobility After the surgery, Mr. Aston will face the problem of restricted mobility since his left leg will be amputated. He will have to rely on aids and wheelchairs to get around. It will take him some time before he is independent again. 4 Toileting Mr. Aston will require the use of aids to get to the toilet. He will also need a toilet frame for pivoting transfer. 5 Pain While the operation saved his life and reduced the pain, Mr. Aston will always have to deal with residual limb pain and phantom stump pain. 6 Balance The amputated leg will leave the patient unable to have proper balance. As a result the patient will be prone to falls. 7 Washing The patient will be able to independently was if he is seated 8 Wound Infection Possible wound infection if proper cleaning and drying is not well done 9 Oedema Can occur if Mr. Aston forgets to properly wrap the residual stump before going to bed. Appendix B: Intervention and initial treatment goals. 1 Help the patient to perform basic activities such as functional transfers 2 Help the patient in maintaining range of motion to prevent hip or knee contractures. 3 Help the patient to learn proper wheelchair positioning 4 Help the patient to learn how to conserve energy 5 Help the patient to learn home exercises that they can perform at home independently 6 Help the patient to restart walking with an assistive device that is the least restrictive 7 Help the patient to start stairs climbing stairs 8 Teach the patient to maintain the prosthesis 9 Teach the patient how to use shrinkers 10 Help the patient in setting up an exercise regime for home usage 11 Show the patient the best exercises to do while at home. Read More